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Concussion

Mild traumatic brain injury (MTBI)

Key points about concussion

A concussion is a mild brain injury. It happens when a bump, blow or shake to your head or body causes your brain to shake inside your skull.
A concussion affects how your brain functions and may occur with or without loss of consciousness.
Symptoms include headache getting worse, confusion, slurred speech, double vision, being sleepy and difficult to wake and vomiting (see more below).
If you have experienced a concussion, see a doctor as soon as possible.

Woman sits outside with head injury having fallen off bike

(Doc Mike Evans, 2015)

If you, or someone else, has had (or may have had) a concussion, it needs to be taken seriously. See your doctor as soon as possible.

Warning signs to watch for
The first 24 hours after having a brain injury are crucial. You should seek urgent medical help (either go to A&E or call 111 for an ambulance) if you or someone you are caring for:
has a headache that gets worse, that is not relieved with simple pain relief like Paracetamol is very sleepy or difficult to wake is confused or doesn’t recognise you has fits or seizures (repeated jerking movements of arms, legs or face) has strange feelings or loss of movement down one side of the body slurs their speech has blurred vision bad enough to stop seeing properly has double vision is increasingly irritable or restless repeatedly vomits (more than 1 vomit for an adult, any vomit for a child) complains of neck pain has behavioural changes passes out. See other symptoms of concussion. Call Healthline free on 0800 611 116 if you are unsure what to do.
Anyone who knocks their head (playing a sport or through a fight or accident) and gets up straight away, still needs to be closely watched as they may develop symptoms after the injury, usually within that day. If they show any of the danger signs above, they need to see a doctor as soon as possible.
Likewise, anyone who is knocked out, ie, is unconsciousness and can't be woken up, even if only for a few seconds, needs to see a doctor urgently. This is to check for a skull fracture or serious brain injury.

A concussion is a type of mild traumatic brain injury (mTBI). It occurs when a bump, blow or shake to your head or body causes your brain to shake inside your skull, causing your brain to be bruised in a similar way to other parts of the body.

You don't have to get a blow directly to your head itself – impact anywhere on your body that causes your head to shake violently can lead to a concussion.

You also don't have to be knocked out to get a concussion. In fact, loss of consciousness only happens with 10% of concussions.

The following video by Dr Mike Evans provides a useful summary of the key points to know.

A concussion can happen to anyone. Common events causing concussion include the following:

- Falls. These are the most common cause of concussion overall, particularly in older adults and young children.
- Vehicle-related collisions. Collisions involving cars, motorcycles or bicycles – and pedestrians involved in such accidents.
- Domestic violence. This, child abuse and other assaults are common causes.
- Sports injuries. Concussions are a common type of sports injury. Higher risk sports for concussion include contact activities such as boxing, martial arts, rugby union and rugby league. It can also occur in any sport with fast movement or balls, including cycling, equestrian activities, cricket, hockey, water polo, snow sports but can occur across all sporting activities.

Symptoms of concussion or mild traumatic brain injury (mTBI) may not appear for hours, days or until you are challenged (physically or mentally) following a head injury.

Warning signs
The first 24 hours after having a brain injury are crucial. You should seek urgent medical help (either go to A&E or call 111 for an ambulance) if you or someone you are caring for shows any of the warning signs in the table above.

If you have had a concussion, or think you have a concussion, it needs to be taken seriously. See your doctor as soon as possible if you notice any of the following signs of concussion.

Some immediate signs of a concussion include someone who:

appears dazed
is confused
has poor balance and lack of coordination
answers questions slowly
runs in the wrong direction
forgets events that occurred before and after impact
vomits
loses consciousness – but it is important to remember that a person can have a concussion without losing consciousness
is seen falling to the ground like a rag doll after a hit, with no signs of trying to protect themselves in the fall
displays seizure-like activity.

A person complaining of the following symptoms may also have had a concussion:

headache
double or blurred vision
confusion
fatigue (tiredness) – usually more tired than they would be after the event
poor concentration
difficulty remembering things
sleep difficulties, either getting to sleep, waking through the night or longer sleep periods
emotional changes including irritability, sadness, tearful sensitivity to noise and light
feeling slowed down as if things around you are going faster and you cannot keep up
lightheaded and dizziness
feeling off balance, like you are on a rocking boat

Not every sign and symptom will be present in every person and some may not appear for hours or days following a head injury.

Fortunately, these symptoms are usually temporary. But if you don't let your brain fully recover after an injury, a concussion can lead to permanent damage.

If you get a concussion, you need to be seen by a doctor. The first 24 hours after the bump or blow are critical, as this is when serious complications are more likely to occur. It is really important you are not alone and someone monitors how you are doing.

In the first 24 hours following your concussion:

Rest as much as possible, but do not to go to sleep in the first 4 hours. After that, you need a normal night’s sleep at the normal time.
If there is any concern about the severity of the injury, it is safest on the first night to gently wake the sleeper every 2 hours and ask them to answer a simple question. If they can’t be woken normally, then get medical help urgently.
Avoid alcohol, sleeping pills and illegal drugs – these can hide problems that might be developing.
Take paracetamol if needed for headache.
Don’t drive a motor vehicle.
Avoid physical activity.

After a doctor has seen you, most people with symptoms of concussion recover without treatment, but rest is important. If your doctor has advised you to stay off work or sport, do so until you have no symptoms and your doctor says you are ready to return.

If at any point symptoms get worse, or if more serious symptoms develop (see warning signs above) see a doctor straight away.

If your symptoms continue for more than 2 weeks, see your doctor again. For people with ongoing symptoms, referral through ACC to a Concussion Service may be needed.

ACC’s Concussion Service(external link)(external link) provides early intervention rehabilitation services for ACC clients with a mild to moderate traumatic brain injury.
The referral form (ACC883) can be downloaded from the ACC website.
Referrers are recommended to send the referral directly to the client’s nearest ACC Short Term Claims Centre.

If you have had a concussion, see a doctor and do NOT return to sports activities or work (where any further injury is a risk) before you have been cleared as safe to do so.

The effects of repeated concussions build up. If you get a second injury before the first one has healed properly, you can end up with a more serious injury. A second concussion can cause acute brain swelling and bleeding. This can be difficult to treat and can lead to permanent disability, even death.

Your brain needs rest to recover from a concussion. Ignoring your symptoms and trying to “tough it out” can make symptoms worse. Recovery is faster when you rest immediately following the injury, seek medical advice and go back to your normal daily activities gradually.

Don't increase your activity level until you are cleared by a doctor to do so – it's not worth the risk.

Many adults recover from a concussion within 2 weeks. For children and teenagers (under 18 years old) recovery can take longer, averaging around 4 weeks.

Some people have symptoms that will last longer. This is now known as persistent concussion syndrome.

To improve your recovery, follow these rules:

Physical and mental rest is advised for the first 48 hours after the injury. After this, seek advice regarding making a plan for a gradual return to normal activates.
Avoid anything that stimulates your brain too much – screens, loud music, noisy environments.
Stay off work until you are told by a doctor that you can return. Discuss a gradual return to work (reduced work hours and lighter duties) with your doctor and employer, if necessary.
Avoid hard physical activities, especially contact sports, for at least 3 weeks. Do not return until you have no symptoms and have been cleared by your doctor to do so. A second concussion within a short time of the first one can be disastrous.
Ask your family/whānau and friends for support. They may also need to get some support to understand and help you with your recovery.